Should more patients continue aspirin therapy perioperatively? Clinical impact of aspirin withdrawal syndrome

Neal Stuart Gerstein, Peter Schulman, Wendy Hawks Gerstein, Timothy Randal Petersen, Isaac Tawil

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: To provide an evidence-based focused review of aspirin use in the perioperative period along with an in-depth discussion of the considerations and risks associated with its preoperative withdrawal. Background: For patients with established cardiovascular disease, taking aspirin is considered a critical therapy. The cessation of aspirin can cause a platelet rebound phenomenon and prothrombotic state leading to major adverse cardiovascular events. Despite the risks of aspirin withdrawal, which are exacerbated during the perioperative period, standard practice has been to stop aspirin before elective surgery for fear of excessive bleeding. Mounting evidence suggests that this practice should be abandoned. Methods: We performed a PubMed and Medline literature search using the keywords aspirin, withdrawal, and perioperative. We manually reviewed relevant citations for inclusion. Results/Conclusions: Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation. Most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period. When aspirin is held preoperatively, the aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication. For many operative procedures, the risk of perioperative bleeding while continuing aspirin is minimal, as compared with the concomitant thromboembolic risks associated with aspirin withdrawal. Those cases where aspirin should be stopped include patients undergoing intracranial, middle ear, posterior eye, intramedullary spine, and possibly transurethral prostatectomy surgery.

Original languageEnglish (US)
Pages (from-to)811-819
Number of pages9
JournalAnnals of Surgery
Volume255
Issue number5
DOIs
StatePublished - May 2012

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Aspirin
Therapeutics
Perioperative Period
Hemorrhage
Transurethral Resection of Prostate
Operative Surgical Procedures
Risk Management
Middle Ear
Secondary Prevention
PubMed
Fear
Spine
Cardiovascular Diseases
Blood Platelets

ASJC Scopus subject areas

  • Surgery

Cite this

Should more patients continue aspirin therapy perioperatively? Clinical impact of aspirin withdrawal syndrome. / Gerstein, Neal Stuart; Schulman, Peter; Gerstein, Wendy Hawks; Petersen, Timothy Randal; Tawil, Isaac.

In: Annals of Surgery, Vol. 255, No. 5, 05.2012, p. 811-819.

Research output: Contribution to journalArticle

Gerstein, Neal Stuart ; Schulman, Peter ; Gerstein, Wendy Hawks ; Petersen, Timothy Randal ; Tawil, Isaac. / Should more patients continue aspirin therapy perioperatively? Clinical impact of aspirin withdrawal syndrome. In: Annals of Surgery. 2012 ; Vol. 255, No. 5. pp. 811-819.
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